Extensive bed and theatre shortages are still an ongoing concern at Birmingham Children’s Hospital, a year after consultants first raised concerns, a review has revealed.

The Care Quality Commission (CQC) released a review on failings at the hospital saying managers had made significant improvements in the past year, but there was still much more to do over capacity of wards and cancelled operations.

A damning report was prompted last year following concerns by visiting consultants from Edgbaston’s Queen Elizabeth Hospital (QE).

They complained that theatre nurses could not identify surgical equipment and instigated a report which ruled there was poor management, a shortage of theatres, staff and beds leading to surgery delays and cancelled operations at the Steelhouse Lane hospital.

Despite CQC inspectors finding hospital chiefs had met six of last year’s 12 recommendations and are making progress on the others, they reported this week lingering concerns over operations and not enough beds forcing children to other hospitals.

Cancelled operations have started to improve slightly but worsened between April and October last year, being higher than the same period in the previous two years.

Inspectors said in the report: “Some staff said access to theatres remained difficult. Plans are being developed, but the situation on the ground has not yet improved for neurosurgery and urgent or emergency liver surgery.

“Within the liver unit, 91 medical liver patients on the trust’s priority list either had a delayed admission (81 patients) or were admitted to another hospital (10 patients) between December 2008 and December 2009.

“The efforts of the trust to admit patients are clearly hampered by the constant bed pressures within the trust, as a result of operating with high bed occupancy rates.”

Chief executive Sarah Jane Marsh said it could take another year to fully address issues in the renal and liver transplants, craniofacial surgery, neurosurgery and interventional radiology departments.

“Overall, I feel very positive as things that could be addressed in short to medium term have been, like more equipment and staff,” said Miss Marsh.

“Some things have got a lot further to go as we have not invested in the estate as much as we should have done over the past five years.

“We have cut the number of children turned away every month from 70 down to between 40 and 50 depending on demand for services. Some of them are for minor things and they go to other hospitals like Walsall and Redditch.

“On cancelled operations, it is getting better and we have plans for two new theatres with the first opening in July, but they are long term projects.

“We have now got doctors and nurses involved in decision making. If there is ever a problem again, we will address it.”

The chief executive added that she had also actioned a £6.7m investment to increase paediatric intensive care unit beds from 20 to 31 plus £8.9m to improve and increase the number of theatres, including the first new cardiac hybrid theatre in the UK and two theatres for laparoscopic and emergency surgery.

The CQC did note that the Children’s Hospital had made headway in improving relations with University Hospitals Birmingham Trust and its consultants after bringing in new chief executive Miss Marsh and new medical director Dr Vin Diwakar.

“There is no question that the trust has made significant progress, particularly in the way it works with University Hospitals Birmingham and in providing more staff for some specialist services. But there is more to do in managing capacity and improving the way it prioritises children needing urgent surgery.

“We will continue to monitor the trust through our tough new registration system.”

THE FINDINGS - How the hospital has improvedRecommendation 1: To actively monitor the demand and capacity for children’s services - “Partly Met”- Hospital has not yet developed system for collecting and monitoring data on unmet demand. Extra ward clerks recruited.

Recommendation 2: To review policies to improve management of admissions and beds, and ensure patients needing urgent care in neurosurgery and liver wards are admitted in a timely manner - “Mostly Met”- Trust aims to reduce length of patients’ stay to reduce bed occupancy rate, cancelled operations, and delays in admissions. Bed meetings are held daily and twice daily during periods of pressure and managers using a Daily Capacity Management Tool to predict demand

Recommendation 3: Work actively to manage demand and provision of paediatric services - “Mostly Met”-Troubleshooters from NHS Interim Management and Support helped managers better understand its capacity, demand and patient flows and improved their planning. More theatre sessions for interventional radiology, craniofacial surgery and renal transplants but neurosurgery consultants said number of beds of 14 on Ward 10 was still not sufficient for numbers that need to be admitted.

Recommendation 4: Review the way it organises capacity and prioritises cases within theatres so emergency surgery patients treated quickly - “Partly Met”- The hospital has insufficient theatre and day case capacity and limited dedicated time for urgent cases. Current theatre lists have 94 per cent usage and doubtful that theatre efficiency could be improved further. Evenings and weekend sessions added to reduce backlog but bosses have identified a need for a further 40 theatre sessions to be staffed and funded a week on a regular basis. Plans to build a dedicated theatre day case unit but will take up to two years to see this created. Access to emergency theatres is still a significant problem

Recommendation 5: Needs a clear plan to ensure that it has the capacity and systems in place to provide sufficient and timely access to interventional radiology - “Met”- Extra sessions to expand the service. Recruited more theatre staff and two extra specialist consultants, increasing the number to eight, which has helped the waiting time for interventional radiology has decreased from over a year to around six weeks.

Recommendation 6: Must ensure theatre support for urgent renal transplants and neurosurgery at all times - “Met”- Two Queen Elizabeth Hospital theatre nurse going into hospital to support theatre staff during renal transplants and 20 theatre nurses sent to QE since May 2009 for training.

Recommendation 7: Need to provide support and equipment for QE consultants for interventional radiology, neurosurgery and renal transplants - “Met”

Interventional radiologists satisfied that the issues over equipment have been addressed. Consultants worked with the trust to agree an inventory.

Recommendation 8: Review urgently arrangements for Hospital at Night in liver department with senior medical staff to address concerns - “Partly Met”- Service needs further examination.Two extra posts and one fellow from the Royal College of Surgeons employed for one year. Overall, the question of medical cover at night for paediatric liver patients remains outstanding. Trust plans to commission an independent external review of the Hospital at Night model.

Recommendation 9: Make a clear plan for craniofacial patients to be treated at the appropriate age and that any delays minimised - “Met”- A workforce and capacity plan saw extra theatre sessions and additional funding to clear the backlog of 18 patients. The age at which craniofacial operations take place in the trust has lowered, but it is too early to draw any conclusions with regard to this.

Recommendation 10: Develop better, formal, communication with QE consultants undertaking work at the trust, to ensure that any concerns are identified and addressed in a timely manner - “Mostly Met”- The staff we spoke to told us that the new management has put a lot of effort into improving relations with QE and its consultants, who said they are much clearer on the protocols for raising concerns, and most felt confident that concerns are being listened to and acted upon by managers within the trust.

Recommendation 12: The Children’s Hospital and QE to agree a model of care delivering high-quality paediatric services - “Met”- Both hospital trusts and overseeing body Monitor have agreed a set of outcomes that the two trusts will work towards.